Recently, it has been demonstrated that the identification of myocardial ischemia should be essential for decision-making of the treatment strategies in patient with coronary artery disease (CAD) compared with anatomical information alone. Furthermore, not only the presence but also the area at risk more than 10% of myocardial ischemia has been reported to be important to improve the prognosis of CAD patients by invasive treatment, whether it would be percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), compared with optical medical therapy. Fractional flow reserve (FFR) or instantaneous flow ratio (iFR) may allow us to demonstrate myocardial ischemia in cardiac catheterization laboratory and Class I or IIa recommendation has been proposed in the guidelines to prove myocardial ischemia in cases without any evidence of ischemia and to guide for PCI in multi-vessel disease. Although stress ECG, stress myocardial perfusion image or stress echocardiography has been applied to demonstrate myocardial ischemia, many non-invasive or semi-invasive methods such as MRI perfusion image, fusion images of myocardial perfusion image with coronary MSCTA, FFR-CT or QFR have been recently developed in daily clinical practice, and these may change the patients’ flow in daily clinical practice. In this session the present status and future perspectives of these methodologies would be discussed among the exparts.